Topical and subconjunctival anesthesia for phacoemulsification: prospective study.
OBJECTIVE
To evaluate the efficacy and safety of topical and subconjunctival anesthesia for phacoemulsification and to compare the results with those of retrobulbar-peribulbar anesthesia.


METHODS
This prospective study evaluated 402 patients having phacoemulsification during 60 surgical sessions. Patients were randomly assigned to receive a topical and subconjunctival injection of lidocaine 4% or a retrobulbar injection of the same anesthetic.


RESULTS
Patients who received topical and subconjunctival anesthesia received less anesthetic (0.25 versus 3.25 mL) and had fewer side effects from the intravenous sedation and a lower incidence of capsular rupture associated with positive vitreous pressure during surgery (0 versus 2.9%). The difference in postoperative discomfort was not statistically significant, and there were no complications resulting from needle insertion.


CONCLUSIONS
Topical and subconjunctival anesthesia using lidocaine 4% was as effective as retrobulbar and peribulbar anesthesia for routine phacoemulsification. In addition, fewer anesthetic drugs and less patient sedation were required, and there were fewer intraoperative and postoperative complications.
Shammas
H J
HJ
Department of Ophthalmology, University of Southern California, USA.
Milkie
M
M
Yeo
R
R
D000287:Administration, Topical; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D003228:Conjunctiva / Q000187:drug effects; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D007267:Injections; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D009883:Ophthalmic Solutions; D009915:Orbit / Q000187:drug effects; D018918:Phacoemulsification; D011183:Postoperative Complications; D011247:Pregnancy; D011446:Prospective Studies; D012449:Safety; D013874:Thiopental / Q000008:administration & dosage; D014792:Visual Acuity
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D008012:Lidocaine; D013874:Thiopental